EBOLA IN WEST AFRICA PREVENTION RELATIVE TO TREATMENT AND MANAGEMENT OF DISEASE CASE STUDY

HOT ZONE DEBRIEF Select a passage from the text that you found interesting and would like to share Read your passage to an elbow partner and discuss its content and impact

“HOT ZONE” DEBRIEF Background: “Hot Zone” was released in 1994 and has recently found itself back on the New York Times bestseller list (number 7). With an elbow partner, discuss the following questions based on your “Hot Zone” excerpt: What was your immediate reaction to the reading? How do you think Preston’s description of Ebola symptoms impact perception of the disease by people with no medical knowledge of Ebola? How can this either help or harm global response to the recent Ebola outbreak?

OBJECTIVE The syllabus says... Discuss the geographic factors that determine the relative emphasis placed by policy-makers, in one country or region, on prevention as opposed to treatment of disease and evaluate the management strategies that have been applied in any one country or region for one disease.

TAKE A MINUTE TO “UNPACK” THESE EXAM QUESTIONS Referring to one or more diseases, discuss the factors that determine the relative importance of policies of disease prevention as opposed to policies of treatment. Evaluate the management strategies that have been applied in any one country or region for one disease.

LET’S DECONSTRUCT OR “UNPACK” THE FIRST QUESTION TOGETHER You are asked to “discuss the factors that determine the relative importance”. What does it mean to “Discuss”? This means looking at the factors that determine medical policies and explaining why treatment is more commonly adopted than prevention (and vice versa) with some diseases.

WITH YOUR PARTNER, UNPACK THE SECOND QUESTION TOGETHER… Evaluate the management strategies that have been applied in any one country or region for one disease. What does it mean to “evaluate” ?

PREVENTION VERSUS TREATMENT If prevention measures are not used, illness can become established in an area. It is often more expensive to treat an illness or condition that has developed, rather than prevent it's establishment in the first place.

CASE STUDY: EBOLA IN WEST AFRICA

WHAT IS EBOLA What is the Ebola virus? A disease that causes a severe, often fatal illness in humans How can you get Ebola? Virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission via direct contact Direct contact with the blood, secretions, organs, or other bodily fluids of infected individuals OR direct contact with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids

SYMPTOMS AND SIGNS OF EBOLA Symptoms may appear 2-21 days after exposure

OUTBREAK Ebola first appeared in 1976 with two simultaneous outbreaks; however, the current outbreak in West Africa (beginning in March 2014) is the largest and most complex The current outbreak began in Guinea and then crossed borders to Sierra Leone, Liberia, and Nigeria

TREATMENT OPTIONS Currently no vaccine or specific treatment Limited to supportive therapy Balancing patient’s fluid and electrolytes, maintaining their oxygen status and blood pressure, and treating any for any complicating infections

LEADING CAUSES OF DEATH IN AFRICA Death (000s) source: who 2012

DEMOGRAPHIC IMPACT

IMPACT ON HEALTH CARE WORKERS

EBOLA PREVALENCE BY AGE GROUPS IN UGANDA OUTBREAK ( ) Fatality rates by age ranges: Children 6-21 died in 40% of cases Adults 21 and over died in 57% of cases Reasons why children (5-21) fight off Ebola better: Better immune systems Less likely to have poor health behaviors (i.e. smoking) Less likely to be a primary caretaker Increased amount of orphans a-liberia-orphans/ (2:30) a-liberia-orphans/

ECONOMIC IMPACT

INDIVIDUAL LEVEL Incubation period (8-10 days) Symptoms typically appear within 8-10 days of exposure Very little direct impact during this time After 10 th day Period of escalating illness Cannot work while ill Difficult to find work or interact with others after survival (stigmatized)

HOUSEHOLD LEVEL Often, more than one household member is infected due to nature of transmission Infections are concentrated among the primary care givers and earners

LABOR MARKET Ebola related illness leads to: Reduced productivity due to absenteeism, high turnover, etc. Reduced cross-border trade due to fear of spreading disease Ebola related death leads to: Change in labor force and labor participation Change in available skills and experience

GOVERNMENT FINANCE Increased demand on government services Health Welfare Poverty reduction Although demand will increase, the level of spending on services will be determined by policy decisions

SOCIAL IMPACTS

SYSTEMS Health care Increased demand Decreased ability to offer services as a result of staff loss Similar impact on Welfare services Education Greater reduction in ability to offer services Example: 1.5 million school-aged Liberian children unable to attend school

EBOLA AND POVERTY Poverty can lead people to behavior which results in increased risk of infection Driven to forests for food Lack of education on disease Overcrowded living conditions Can’t afford or access basic medical care Ebola increases poverty

TREATMENT/MANAGEMENT OF DISEASES Poor people generally: Have less access to health services Are more vulnerable to diseases Treatment of diseases in many developing countries is therefore difficult once an illness is established. A more effective and much less costly way of containing disease is to prevent its occurrence and present barriers to its spread.

PREVENTION Case management Surveillance and contact tracing Good laboratory service Safe burials and social mobilization Community engagement Public awareness Access to health centers

LET’S GO BACK TO THE QUESTIONS Referring to one or more diseases, discuss the factors that determine the relative importance of policies of disease prevention as opposed to policies of treatment. Evaluate the management strategies that have been applied in any one country or region for one disease.

HOW WILL THIS CASE STUDY WORK? Materials You’ll Need: These notes (especially for background information) All Videos/Articles-Textual Evidence Video Analysis Guide Essay Planning Tools: one for each question

ARTICLES/TEXTUAL EVIDENCE “Hot Zone” excerpt “Short Staff Tries to Cope with Ebola” from NY Times “Nigeria Declared Ebola-Free, Holds Lessons for Others” from Reuters

VIDEO 1 Survivor’s Testimony (2:53) -

VIDEO 2 Burial Practices (3:17) -

VIDEO 3 Farmerline Ebola audio message (1 minute) Farmerline is an African-led company that offers agriculture information by voice calls and SMS to rural farmers in local languages This particular message was delivered to 2,000 people in rural Ghana Individuals could respond with questions or concerns Program is spreading to Liberia, Guinea, Sierra Leone and Nigeria

VIDEO 4 World Bank perspective on outbreak (2:30) - science/ebolas-lessons-painfully-learned-at-great- cost-in-dollars-and-human- lives/2014/12/28/dcc8c50a-87c2-11e4-a702- fa31ff4ae98e_story.html science/ebolas-lessons-painfully-learned-at-great- cost-in-dollars-and-human- lives/2014/12/28/dcc8c50a-87c2-11e4-a702- fa31ff4ae98e_story.html

VIDEO 5 “The Fight Against Ebola” (29:19) Finish watching for homework please :)